Purpose: This study aimed to investigate the clinical alarm occurrence and management of nurses toward clinical alarms in the intensive care unit (ICU). Methods: This observational study was conducted with 40 patients and nurses cases in two ICUs of a university hospital. This study divided 24 hours into the unit of an hour and conducted two times of direct observation per unit hour for 48 hours targeting the medical devices applied to 40 patients. Data were analyzed using IBM SPSS Statistics 23. Results: On average, 3.8 units of medical devices were applied for each patient and the ranges of alarm settings were wide. During 48 hours, 184 cases of clinical alarm were occurred by four types of medical devices including physiological monitors, mechanical ventilators, infusion pumps, and continuous renal replacement therapy. Among them, false alarm was 110 cases (59.8%). As for the alarm management by ICU nurses, two-minute alarm mute took up most at 38.0% (70 cases), and no response was second most at 32.6% (60 cases). When valid alarm sounded, nurses showed no response at 43.2%. Conclusion: The findings suggest that a standard protocol for alarm management should be developed for Korean ICU settings. Based on the protocol, continuous training and education should be provided to nurses for appropriate alarm management.
Purpose: This study was conducted to identify changes in limb circumferences among patients admitted to the intensive care unit (ICU) and related factors. Methods: We conducted a prospective observational study with 27 patients from 3 ICUs at a university hospital located in B city of Korea, from September 1 to October 30, 2015. The circumferences of the left and right upper arms, thighs, and lower legs were measured on the first, third, fifth, and seventh days of ICU admission. Information on the related factors was collected from the medical records. The data were analyzed using a linear mixed model method. Results: The limbs circumferences significantly reduced from day 3, and the changes continued till day 7. These changes were related to the gender of the subjects, restraints application, use of steroids, and continuous renal replacement therapy. Conclusions: Based on the above results, it can be concluded that ICU-acquired weakness begins before the third day of admission. Thus, early mobilization protocols for ICU patients need to be developed and implemented in order to improve long-term outcomes.
Purpose: Methicillin-resistant Staphylococcus aureus (MRSA) is a major nosocomial pathogen in the intensive care units (ICUS). The purpose of this case-control study is to identify risk factors for acquisition of MRSA during ICU stays in patients with and without MRSA. Method: The study was conducted in a 16 beds-neurosurgical intensive care unit of a 2200-bed tertiary care university hospital in Seoul, Korea. Medical record and Critical Classification Scoring System were reviewed retrospectively in patients who were admitted more than 3 days from August 1, 2003 to May 30, 2004. Cases and controls were matched for age and gender. The obtained specimens were nasal swab and sputum. Result: There were 950 patients' admissions during the period. Among them, MRSA was isolated from twenty-three patients who were considered as hospital acquired. Artificial airway (p=.045), frequency of suction (p=.002), nasogastric tube (p=.004), wound drain (p=.045), and vancomycin (p=.019) were risk factors for MRSA acquisition in univariate analysis. Frequency of suction (p=.012, OR 3.5) was revealed as the only risk factor in multivariate conditional logistic regression. Conclusion: Our findings give support to recent studies that suggest that frequent physical contact maγ increase the nosocomial acquisition of MRSA in a neurosurgical ICU.
Purpose: The purpose of this paper is to develop a predictive model for patient visibility in Korean ICUs (corridor or continental type). Methods: The measures of static visibility were used to quantify the patient visibility (upper third part of the patient bed) from the nurse station. The measure of space programme and area distribution (patient zone percentage, staff zone percentage and departmental gross square meter per patient bed) were calculated by using AutoCAD and MS Excel programs. Regression analysis was conducted for visibility as dependant variable with independent variables of patient area percentage, staff area percentage as well as departmental gross square meter per bed by using IBM SPSS. Results: (1) Average patient visibility and percentage of patient area in ICU shows a strong negative correlation ($r^2$=0.66), p=0.01. (2) Patient visibility in Korean ICU (corridor or continental type) can be calculated as below with the given conditions: Y= $-1.449(X)+124.3{\pm}6$, Y is the total visibility of the ICU (corridor or continental type) and X is the percentage of patient area in the unit. Conditions:1. Given that the unit has a mixed programme of open bed and closed patient rooms and 2. The unit have a minimum of 20% patient rooms. Implications: This study may contribute to the visibility analysis of existing and future ICU design (corridor or continental type) in Korea to achieve maximum patient visibility and reduced patient mortality.
Purpose: The purpose of this study was to calculate the total daily nursing workload and the optimum number of nurses per intensive care unit (ICU) based on the nursing intensity and the direct nursing time per inpatient using the patient classification. Methods: Two ICUs at one general hospital were investigated. To calculate the nursing intensity, patient classification according to the nursing needs was conducted for 10 days in each unit during September 2018. We performed patient classifications for a total of 167 patient-days in the Medical Intensive Care Unit (MICU) and 86 patient-days in the Surgical Intensive Care Unit (SICU). The total number of person-days for nurses who responded to the Nursing Time survey was 151 for MICU and 85 for SICU. In each unit, direct and non-direct nursing hours, nursing intensity score, and direct nursing hours were analyzed using descriptive statistics such as frequency, percentage, and average calculated using Microsoft Excel. The amount of nursing workload and the optimum number of nurses were calculated according to the formula developed by the authors. Findings: For the MICU, the average direct nursing time per patient was 5.59 hours for Group 1, 6.98 hours for Group 2, and 9.28 hours for Group 3. For the SICU, the average direct nursing time per patient was 5.43 hours for Group 1, 7.21 hours for Group 2, 9.75 hours for Group 3, and 12.82 hours for Group 4. Practical Implications: This study confirmed that the appropriate number of nurses was not secured in the nursing unit of this study, and that leisure time such as meal time during nursing work hours was not properly guaranteed. The findings suggest that to create working environments where nurses can serve for extended periods of time without compromising their professional standards, hospitals should secure an appropriate number of nurses.
Purpose: The purpose of this study was to identify the relationship between organizational culture and workplace bullying of intensive care unit (ICU) nurses. Methods: A secondary analysis was conducted using three different data sets on workplace bullying of hospital nurses. This analysis focused on the relationship between organizational culture and workplace bullying of 240 ICU nurses. The original data were collected using self-reporting questionnaires and were analyzed using hierarchical multiple regression. Results: ICU nurses were aware of their organizational culture as being rank-oriented, relationship-oriented, innovation-oriented, and task-oriented in that order. The results showed that 15.0% of the ICU nurses reported being victims of workplace bullying, mostly work-related bullying. The perception of a relationshiporiented culture explained a variance of 29% in the workplace bullying of ICU nurses. Conclusion: The findings suggest that ICU nurses who are strongly aware of a relationship-oriented culture would experience less workplace bullying. Further research is needed to develop interventions that can foster a relationship-oriented culture in ICUs.
Purpose: This study aimed to investigate the involvement of patients who died from hematologic neoplasms in the decision-making process surrounding the withdrawal of life-sustaining treatment (LST). Methods: A total of 255 patients diagnosed with hematologic neoplasms who ultimately died following decisions related to LST during their end-of-life period at a university hospital were included in the study. Data were retrospectively obtained from electronic medical records and analyzed utilizing the chi-square test, independent t-test, and logistic regression. Results: In total, 42.0% of patients participated in the decision-making process regarding LST for their hematologic neoplasms, while 58.0% of decisions were made with family involvement. Among these patients, 65.1% died in general wards and 34.9% in intensive care units (ICUs) as a result of decisions such as the suspension of LST. The period from the LST decision to death was longer when the decision was made by the patient (average, 27.15 days) than when it was made by the family (average, 7.48 days). Most decisions were made by doctors and family members in the ICU, where only 20.6% of patients exercised their right to make decisions regarding LST, a rate considerably lower than 79.4% observed in general wards. Decisions to withhold or withdraw LST were more commonly made by patients themselves than by their families. Conclusion: The key to discussing the decision to suspend hospice care and LST is respecting the patient's self-determination. If a patient is lucid prior to admission to the ICU, considerations about suspending LST should involve the patient input.
Seo, Hye Kyung;Hwang, Joo-Hee;Shin, Myoung Jin;Kim, Su young;Song, Kyoung-Ho;Kim, Eu Suk;Kim, Hong Bin
Journal of Korean Medical Science
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제33권45호
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pp.280.1-280.9
/
2018
Background: Surveillance and interventions of central line-associated bloodstream infections (CLABSIs) had mainly been targeted in intensive care units (ICUs). Central lines are increasingly used outside ICUs. Therefore, we performed a hospital-wide survey of CLABSIs to evaluate the current status and develop strategies to reduce CLBASI rates. Methods: All hospitalized patients with central venous catheters (CVCs) were screened for CLABSIs from January 2014 through December 2015 at a 1,328 bed tertiary care teaching hospital in Korea using an electronic data-collecting system. Clinical information including type of CVC was collected. CLABSI rates were calculated using the definitions of the National Health and Safety Network after excluding mucosal barrier injury laboratory-confirmed bloodstream infection (BSI). Results: A total of 154 CLABSIs were identified, of which 72 (46.8%) occurred in general wards and 82 (53.2%) in ICUs (0.81 and 2.71 per 1,000 catheter days), respectively. Nontunneled CVCs were most common (68.6%) among 70 CLABSI events diagnosed within one week of their maintenance. On the other hand, tunneled CVCs and peripherally inserted central catheters (PICCs) were more common (60.5%) among 114 CLABSI events diagnosed more than a week after maintenance. Whereas the majority (72.2%) of CLABSIs in ICUs were associated with non-tunneled CVCs, tunneled CVCs (38.9%) and PICCs (36.8%) were more common in general wards. Conclusion: CLABSIs are less common in general wards than in ICUs, but they are more often associated with long-term indwelling catheters. Therefore, interventions to prevent CLABSIs should be tailored according to the type of ward and type of catheter.
In Intensive Care Units (ICUs), where severely ill patients are treated, importance of reducing Hospital Acquired Infection (HAI) cannot be overstated. One of the simplest and most effective actions against HAI is proper hand hygiene (HH) behavior of Health Care Workers (HCWs). However, compliance varies across different cultures and different job types of HCWs (physicians, residents and nurses). This study aims to understand determinants of HH behavior by HCWs' job types in Korea. Qualitative analysis was performed based on Reasoned Action Approach style interviews with staff physicians, residents and nurses across 7 teaching hospitals. We found that all HCWs strongly believe HH is important in reducing HAI. There were, however, job type-specific HH behavior modifying factors; staff physicians stated feeling pressure to be HH behavior role model. Residents identified Quality Improvement team that measured compliance as a facilitator; a notable barrier for residents was senior physicians not washing their hands, because they were afraid of appearing impudent to their seniors. Nurses designated their chief nurse as a key referent. All participants mentioned heavy workload and lack of access to alcohol-based sanitizer as situational barriers, and sore and dry hand as deterrents to HH compliance.
Kim, Hyung-Jun;Jeong, EuiSeok;Choe, Pyoeng Gyun;Lee, Sang-Min;Lee, Jinwoo
Acute and Critical Care
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제33권4호
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pp.238-245
/
2018
Background: Infection by multidrug-resistant (MDR) pathogens leads to poor patient outcomes in intensive care units (ICUs). Contact precautions are necessary to reduce the transmission of MDR pathogens. However, the importance of the surrounding environment is not well known. We studied the effects of ICU relocation on MDR respiratory pathogen detection rates and patient outcomes. Methods: Patients admitted to the ICU before and after the relocation were retrospectively analyzed. Baseline patient characteristics, types of respiratory pathogens detected, antibiotics used, and patient outcomes were measured. Results: A total of 463 adult patients admitted to the ICU, 4 months before and after the relocation, were included. Of them, 234 were admitted to the ICU before the relocation and 229 afterward. Baseline characteristics, including age, sex, and underlying comorbidities, did not differ between the two groups. After the relocation, the incidence rate of MDR respiratory pathogen detection decreased from 90.0 to 68.8 cases per 1,000 patient-days, but that difference was statistically insignificant. The use of colistin was significantly reduced from 53.5 days (95% confidence interval [CI], 20.3 to 86.7 days) to 18.7 days (95% CI, 5.6 to 31.7 days). Furthermore, the duration of hospital stay was significantly reduced from a median of 29 days (interquartile range [IQR], 14 to 50 days) to 21 days (IQR, 11 to 39 days). Conclusions: Incidence rates of MDR respiratory pathogen detection were not significantly different before and after ICU relocation. However, ICU relocation could be helpful in reducing the use of antibiotics against MDR pathogens and improving patient outcomes.
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